DISCUSSION: The diagnosis of H. capsulatum infection can be made by culture, antigen or antibody detection, or direct examination of lung tissue. Histoplasmosis has been associated with chronic inflammatory complications including fibrosing mediastinitis. In our patient, the presentation was unique in regards to location of fibrosis. Though mediastinal fibrosis usually affects the superior mediastinum, fibrosis can also affect other mediastinal structures1. When localized to the hilum, the focal fibrosis may produce profound changes in the structure and function of the affected lung which can include obstruction and eventual obliteration of small airways. Histopathology and cytology remain the standard diagnostic approach for endemic mycoses2. Histologic examination may reveal distinct 2-5 µm, oval, narrow-based budding yeasts suggestive of H. capsulatum.